CMS to Reimburse Principal Illness Navigation Billing Codes Starting January 2024

Jasper Health is thrilled to share groundbreaking news that was announced during a recent call hosted by the First Lady and the White House. CMS has made a historic decision to commence reimbursement for Principal Illness Navigation (PINS) billing codes starting in 2024.

This development is a significant acknowledgment of the crucial role that patient and care navigators play in ensuring individuals receive the support they need throughout their cancer journey. First Lady Jill Biden highlighted the impactful role of patient navigators as trusted companions by one’s side, consistently enhancing the overall patient experience and contributing to improved health outcomes.

How will this announcement impact patients? 

Jasper Health was founded on the commitment to deliver high-quality virtual navigation and supportive care to individuals affected by cancer. We have been hard at work scaling the cutting-edge technology and virtual services to reach as many patients as possible in the comfort of their homes. With this new reimbursement path, we are humbled and excited about the opportunity to quickly implement new reimbursable care models with our partners to transform the lives of people affected by cancer. Schedule a demo to learn more how Jasper Health can support your population.

What does this mean for you?

Expanded Services:

Principal Illness Navigation Services (PINS) can now be provided by trained patient navigators or certified peer specialists, offering these services more than once per practitioner per month.

Reimbursement Details:

Key PINS CPT codes for reimbursement include:

  • CPT Code G0023:
    • Principal Illness Navigation Services — additional 60 minutes per calendar month.
  • CPT Code G0024:
    • Principal Illness Navigation Services — additional 30 minutes per calendar month.

Comprehensive Care:

A new SDOH Risk Assessment Code:

  • CPT Code G0136
    • Emphasizes a holistic approach to care, covering Social Determinants of Health.

Specialized Support:

  • CPT Codes G0140 and G0146
    • Designed specifically for PIN services provided by peer support around behavioral health conditions. 
  • CPT Code G2211
    • An add-on code, highlights the importance of the long-term relationship between practitioners and patients.

This reimbursement policy is a game-changer, ensuring that crucial patient navigation services are not only recognized but also financially supported, and we are excited about the positive impact this will have. We are at the forefront of a transformative era in oncology care, where the dedication of patient navigators is rightfully acknowledged. This decision by Medicare reflects a commitment to enhancing patient care and outcomes. We eagerly anticipate the positive ripple effects this will have on cancer patient experiences nationwide.